| NPI | 1306854641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00038000) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA MD00038000) |
| 207Q00000X Family Medicine (Licence: CO DR.0067968) | |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2023-09-18 |